With the latest round of conference calls on the CCC Plus program, it became evident that claims processing issues persist. VHCA-VCAL is disappointed at the slow pace of progress in resolving these issues that have continued into the fifteenth month of implementation of CCC Plus. The association is again pressing the Department of Medical Assistance Services (DMAS) for a quicker path to resolution on these issues. 

VHCA-VCAL has also highlighted these concerns in meetings with other state government leaders and members of the General Assembly as we conduct briefings with them on our 2019 legislative priorities.

The biweekly conference calls with the MCOs, DMAS representatives, and VHCA-VCAL members and staff resumed this week after a month without calls. The following list includes the latest update for each MCO, which vary from plan to plan:

• Aetna and Optima: These calls were canceled this week due to weather-related state offices closure and will be rescheduled.

• Anthem’s custodial (Medicaid LTC) claims processing is working fairly well.  According to feedback on the call, providers are receiving payment on a relatively timely basis. Anthem’s Part B claims seem to work when there is no complexity (patient pay or supplemental insurance), which is similar on the Part A side for the most part.

• Magellan seems to be moving along on custodial, but it appears their Part A logic may have issues, as several providers on the call voiced concern with over payments for Part A.  It appears there may be similar issues with supplemental insurance complicating the Part A and B processing.

• United seems to be moving along on custodial claims, but is also experiencing issues when there is supplemental insurance on crossover claims.  It is researching some incorrect Part A claims to determine if there remains a logic issue or if they are related to a previous issue that has been fixed but perhaps not yet applied to these claims.

• VA Premier is still having some patient pay issues related to the system switch (for custodial, too), some incorrect rates were loaded, and there are a litany of issues with paying correctly under Parts A and B.  In addition, there remains a lot of retro-cleanup which is made more complex given the system switch that occurred in August.

• Finally, all six MCOS are awaiting further guidance from DMAS/ Palmetto on the Part A Bad Debt remittance issue.

Contact Steve Ford, VHCA-VCAL’s Senior Vice President of Policy and Reimbursement with any questions or comments you have on CCC Plus.